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WJOL S
WJOLS

10.5005/jp-journals-10033-1253
Efficacy and Safety of Laparoscopic Inguinal Hernia Repair
REVIEW ARTICLE

Efficacy and Safety of Laparoscopic Inguinal

Hernia Repair

Michael Angelo L Suñaz

ABSTRACT How to cite this article: Suñaz MAL. Efficacy and Safety
of Laparoscopic Inguinal Hernia Repair. World J Lap Surg
Background: Inguinal hernia results from a defect or weak­ 2015;8(3):81-84.
ness in the muscles in the inguinal region, through which
the peritoneum protrudes, forming the sac. One of the most Source of support: Nil
common operations that general surgeons perform to repair this
defect is inguinal herniorrhaphy. Laparoscopic herniorrhaphy Conflict of interest: None
started being performed when laparoscopic cholecystectomy
has shown definite benefits over the open technique. However, INTRODUCTION
laparoscopic hernia repair is an advanced laparoscopic proce­
dure and has a longer learning curve. 4 Inguinal hernia results from a defect or weakness in
the muscles in the inguinal region through which the
Objectives: (1) To evaluate the efficacy and safety of three
laparoscopic hernia repair techniques: Transabdominal preperi­ peritoneum protrudes, forming the sac. One of the most
toneal (TAPP), totally extraperitoneal (TEP), and intraperitoneal common operations that general surgeons perform to
onlay mesh (IPOM). (2) Specifically, this review aims to: (a) repair this defect is inguinal herniorrhaphy. Laparoscopic
Determine which laparoscopic technique has lowest recurrence herniorrhaphy started being performed when laparos­
rate, (b) determine which laparoscopic technique has the least
perioperative complications. copic cholecystectomy has shown definite benefits over
the open technique. However, laparoscopic hernia repair
Materials and methods: The database used in this study
was PubMed and MeSH. Search terms included: laparoscop*, is an advanced laparoscopic procedure and has a longer
inguinal, hernia, repair, TAPP, TEP and IPOM. Study designs learning curve. 4
included in this study were prospective clinical studies, and In 1982, Ger attempted minimal access groin hernia
retrospective clinical studies. repair by using Michel clips to close the opening of an
Results: All three laparoscopic techniques had complication indirect inguinal hernia sac. In 1989, Bogojavlensky
rates comparable to those of the open techniques. However, re­ modified the technique by plugging a polypropylene
currence rates after laparoscopic repair was much lower. IPOM, mesh into the sac and applying an intracorporeal suture
although technically the easiest procedure to perform among the
three laparoscopic techniques, is associated with the highest risk on the deep ring. In 1991, Toy and Smoot described a
of adhesion formation and the lowest tensile strength. In com­ technique of intraperitoneal onlay mesh (IPOM) place­
parison, the TEP and the TAPP techniques had the advantages ment. This involved placement of an intra-abdominal
of better tissue incorporation and tensile strength. piece of polypropylene or e­PTFE mesh and stapling it
Conclusion: Laparoscopic inguinal herniorrhaphy is an effec­ over the myopectineal orifice without dissection of the
tive method to correct an inguinal hernia but is not without peritoneum. 4
complications nor risk for recurrences. The TAPP, IPOM, Stoppa’s concept of preperitoneal reinforcement of
and TEP procedures appear to be equally effective. Training,
experi ence, and proper operative technique will prevent some the transversalis fascia over the myopectineal orifice
of these complications. with its multiple openings by a prosthetic mesh brought
about the evolution of the present day techniques of
Keywords: Hernia, Inguinal, Laparoscop*, Repair, TAPP, TEP
and IPOM. laparoscopic hernia repair. In the early 1990’s, Arregui
and Doin described the transabdominal preperitoneal
(TAPP) hernia repair. During TAPP, the abdominal cavity
Resident Fellow is first entered followed by the incision of the peritoneum
over the posterior wall of the inguinal canal, allowing
World Laparoscopy Hospital, Cyber City, DLF Phase II, Gurgaon
Haryana, India access into the avascular preperitoneal plane. Adequate
Corresponding Author: Michael Angelo L Suñaz, Resident dissection is carried out along this plane to allow
Fellow, World Laparoscopy Hospital, Cyber City, DLF Phase placement of a large (15 × 10 cm) mesh over the hernia
II, Gurgaon-122002, Haryana, India, e-mail: prettytiedup@ orifices. The peritoneum is carefully sutured or stapled
gmail.com
back into place after fixation of the mesh. Transabdominal

*Laparoscop stands for ‘Laparoscopy’ or ‘Laparoscopic’ for PubMed result.
World Journal of Laparoscopic Surgery, September-December 2015;8(3):81-84 81